Frailty and surgical outcomes in gastrointestinal cancer: Integration of geriatric assessment and prehabilitation into surgical practice for vulnerable patients

Abstract

As life expectancy increases, the older population continues to grow rapidly, resulting in increased requirement for surgery for older patients with gastrointestinal cancer. Older individuals represent a heterogeneous group in terms of physiological reserves, co‐morbidity, cognitive impairment, and disability. Owing to the lack of treatment guidelines for vulnerable patients with gastrointestinal cancer, these patients are more likely to be at risk of undertreatment or overtreatment. Hence, the identification of frail patients with gastrointestinal cancer would improve cancer treatment outcomes. Although there is no standardized geriatric assessment tool, a growing body of research has shown associations of frailty with adverse postoperative outcomes and poor prognosis after resection of gastrointestinal tract and hepatobiliary‐pancreatic cancers. Emerging evidence suggests that prehabilitation, which includes exercise and nutritional support, can improve preoperative functional capacity, postoperative recovery, and surgical outcomes, particularly in frail patients with gastrointestinal cancer. We reviewed major geriatric assessment tools for identification of frail patients and summarized clinical studies on frailty and surgical outcomes, as well as prehabilitation or rehabilitation in gastrointestinal tract and hepatobiliary‐pancreatic cancers. The integration of preoperative geriatric assessment and prehabilitation of frail patients in clinical practice may improve surgical outcomes. In addition, improving preoperative vulnerability and preventing functional decline after surgery is important in providing favorable long‐term survival in patients with gastrointestinal cancer. Further clinical trials are needed to examine the effects of minimally invasive surgery, and chemotherapy in frail patients with gastrointestinal cancer.

Risk factors for postoperative delirium in elderly patients undergoing gastroenterological surgery: A single‐center retrospective study

“…Prehabilitation may be effective for patients with a poor physical function, nutritional status, or cognitive function. Prehabilitation is a preoperative multidisciplinary intervention that includes exercise and nutritional support 29 . Mima et al reported that preoperative rehabilitation and nutritional intervention improve surgical outcomes and reduce the incidence of postoperative complications in gastroenterological surgery 29 .…”

“…Prehabilitation is a preoperative multidisciplinary intervention that includes exercise and nutritional support 29 . Mima et al reported that preoperative rehabilitation and nutritional intervention improve surgical outcomes and reduce the incidence of postoperative complications in gastroenterological surgery 29 . Therefore, the prehabilitation of vulnerable patients may reduce the incidence of postoperative delirium.…”

“…29 Mima et al reported that preoperative rehabilitation and nutritional intervention improve surgical outcomes and reduce the incidence of postoperative complications in gastroenterological surgery. 29 Therefore, the prehabilitation of vulnerable patients may reduce the incidence of postoperative delirium. Although geriatric assessments are not routinely performed in the daily clinical setting, it is important to identify frail patients using geriatric assessments such as SPPB, MNA-SF, and MMSE, and to intervene intensively before surgery.…”

Exercise and Nutrition Interventions for Prehabilitation in Hepato-Pancreato-Biliary Cancers: A Narrative Review

“…The number and severity of these established conditions at diagnosis can help to identify patients at the highest risk of experiencing poor surgical outcomes, and, therefore, those who are likely to benefit most from prehabilitation. For instance, patients who are frail are more likely to benefit from prehabilitation given the association of frailty with post-operative complications [55,78]. Thus, assessing risk factors and metrics of frailty and physical function before cancer treatments and operations becomes essential in informing the components of prehabilitation and supporting overall survival [8,72,75].…”

Patient vulnerability is associated with poor prognosis following upfront hepatectomy for colorectal liver metastasis

“…With the rapid aging of populations worldwide, the number of vulnerable patients with cancer has increased [5][6][7]. Accumulating evidence indicates that vulnerable patients with gastrointestinal cancer are more likely to have worse surgical outcomes or poor prognosis [8][9][10]. Hence, identifying and improving perioperative vulnerability or frailty may provide favorable clinical outcomes in these patients.…”